2.0.3 update

Another update to improve the functionality of the app. This includes one resolved issue that prevented one of the four possible possible FAST exams from showing. Most annoying, but now fixed. The monitor portion of the simulation setup randomizes which exam that will be presented, why different examinations/cases now can display different images. This will make interpretations a bit harder, as images will not be instantly recognizable as one or the other of the two possible; normal or pathologic.

 

New feature: app can now be launched directly into either monitor- or remote mode via 3D Touch to the app icon on devices that supports this (6S, 7). This speeds up the process somewhat as you can bypass the start screen, which is always nice if time is of the essence.

Thanks a lot everyone for your support! I know that many new users are coming from recommendations by current users, which truly feels rewarding on its own. If you have the time or interest, leaving a rating for the app in the AppStore (written or star doesn't matter) would help a lot.

Until next time, happy simulations!!!

2.0.2 update

This update fixes a bug that led the app to crash on 12" iPad Pro units if the "Use Device As Remote" button was pressed. Unfortunately a bit of a slip up with my QA process that led to this error, but hopefully not affecting too many users.

If you happen to stumble over any bugs, don´t hesitate to get in touch!

SESAME protocol and advanced cardiac arrest resuscitation

Modern resuscitation mainly differs itself from its past in that focus now now is shifted from just running a protocol, like the ERC Guidelines for CPR, to trying to narrow down the root cause of the collapse by enhancing physiologic monitoring and diagnostics. The use of invasive monitoring of arterial pressure and end tidal CO2 have been getting a lot of attention in the last couple of years and ultrasound is gaining traction as the primary diagnostic tool.

But. Does everyone know how to use this tool in this special situation? Incorporating advanced diagnostics into the already established concept of CPR takes practice and thinking. When to do it, where to look?

Dr. Daniel Lichtenstein have proposed the SESAME protocol as the way to standardize the diagnostic use of ultrasound in cardiac arrest. The protocol specifies a structured approach that can be used to rule in or rule out causes of cardiac arrest, and can be preformed while standard CPR is ongoing.

Listen to Dr. Lichtenstein explaining the concept, or read up on the details.

The main points are to rule in or rule out:

  • Tension pneumothorax
  • DVT in femoral vessels
  • Major bleeding in abdomen or from the aorta
  • Tamponade
  • RV-strain or other cardiac cause

All these diagnoses can be found in the Awesome Ultrasound Simulator, why training easily can be preformed with just a mannequin and two iDevices. Training focus can be to correctly finding and treating the underlying pathology that's causing the arrest while maintaining good compressions. How many persons are required to run the standard protocol with good quality while also expanding the diagnostics this way? How do you communicate your findings to the rest of the team, and how do you tailor your treatment?

Celebrating the new year with an update

It's been almost a year since the Awesome Ultrasound Simulator was released in the AppStore. To celebrate the fact, and to enhance the experience for all of you that have bought the app, a 2.0 version is to be released.

Hopefully soon, but as you all may be familiar with; the final touches are often what takes the longest to finish.

My focus has been to make the app better in the ways that matter concerning its use in simulation, focusing on the features that have been requested in the year that have past. I'm very thankful for all of the feedback that I've got, and I hope that you will make use of the changes and adding in your simulations. If you have any suggestions, please feel free to get in touch!

In the last year, the app have been in use in medical- and trauma- simulation training all over the globe, used in presentations as an interactive way to teach ultrasound, used as a tool for examination at POCUS courses.

Hopefully, the coming year will bring a whole lot more of all of the above, and maybe it can even be used in new contexts?

 

Compatibility issuses with iOS 10?

So. Apple released thier update to version 10 of iOS yesterday. Fundamentally, nothing has really changed 'under the hood' concerning Awesome Ultrasound Simulator, so no issues were to expect. However when using two devices running different versions of iOS (9,10), connecting can sometimes time out. I've seen issues when using the iOS 9 as remote with iOS 10 as monitor, but flipping the roles; iOS 10 as remote and iOS 9 as monitor works well.

After upgrading all devices to iOS 10, connection was again almost immediate and worked both ways.

 

Why this is happening, I don't know. I'll investigate and hopefully work out a fix. Until then my recommendation is to either stay with iOS 9 on all devices, or upgrade everything to iOS 10.

 

Happy simulations!

Teaching using A.U.S. -a few examples

The word about Awesome Ultrasound Simulator is spreading around the world, but more important; It's use in in-situ simulation is real and effective.

In Toronto, Dr. Andrew Petrosoniak is using earlier, actual, trauma cases in the simulation at the emergency department at St Michaels hospital in his TRUST study. POCUS is a critical component to aid the modern doctor in diagnosing and treatment of trauma patients, and simulating the POCUS examination adds both educational value, and added realism to the simulaiton case.

In Amsterdam, Dr. Hans van Schuppen is using Awesome Ultrasound Simulator in advanced CPR training, of his anaestesia residents. POCUS can, and should, be used in every cardiac arrest scenario, both in real life and in simulation.

 

Great work, Hans and Andrew, and good luck with your education endavours!

Version 1.5 - What's new?

Version 1.5, aka 'The C. Wurster asked for it' update!

I've gotten some feature requests and try to fulfil your wishes if possible. So, I hereby give you:

New view: Aorta !!!!
It's now possible to simulate examination of the aorta. For now, I've included sagittal and transverse images of normal vascular anatomy and an aneurysm. Will swap out current aneurysm for any larger or more thrombotised as soon as I can get my probe on one, as the current one not yet fulfils the requirements for operation and looks fairly benign (diameter ~5cm).

Social sharing
Marketing of this app has up until now only consisted of some Tweeting and some very rare demonstrations in person. I'm very happy for every mention, and extremely exited by the few pictures and videos of people actually using the app in their simulation scenarios! If you want, there is now the possibility to share on Twitter or Facebook directly from whit in the app. Unfortunately, Facebook won´t allow for pre-filled sharing sheets, so you will have to come up with something yourself or copy the text from the Twitter share sheet.

Thats it for now. Use the app, spread the word to others that teach ultrasound, simulation or in other ways can benefit from having the ability to simulate POCUS.

Version 1.4 - What's new?

Version 1.4 of Awesome US got released just in time for SMACC DUB and includes a plethora of improvements.

-New and better clips of normal lungs and of the normal A4C view of the heart.

-Improvements to the remote controller portion if the app.

Before v.1.4 the app could malfunction if more than one buton on the controller was pushed down at once. Starting with 1.4 this no longer is the case as only one button can be activated at any given time. Big thanks to the quality testers that are my sons for finding this issue!

-New 'Help'-switch in monitor mode

Got the request from one of the consultants at work to add this feature. Not sure if this is nessecary, but at least I've got a userbase of 1 after this update. Flipping the switch reveals a text interpretation of the current clip. May be that this makes thing too easy for anyone that isn't a consultant, so use with caution...

 

 

 

Version 1.3 released!

Version 1.3 was released yesterday. Biggest change from earker versions is the possibility to include a full ventricle of 'Gastric' content in the LUQ view. Maybe that ventricle should be drained before an intubation of the patient?

Our department has also got a new ultrasound machine (GE S70), which produced much more detail rich pictures than our S6 ones. It has also the option to export images in a less compressed format than my old workflow of 'S6 scans -> Syngo database -> .avi export'. Hopefully I can herefrom update some of the scans with better ones. In this version the old, 'Pleural Effusion' clips are changes to newer ones from this new machine.